Glyburide

Pronunciation

Class: Sulfonylureas
VA Class: HS502
Chemical Name: 1-[[p-[2-(5-Chloro-o-anisamido)ethyl]phenyl]sulfonyl]-3-cyclohexylurea
Molecular Formula: C23H28ClN3O5S
CAS Number: 10238-21-8
Brands: DiaBeta, Glucovance, Glycron, Glynase, Micronase

Introduction

Antidiabetic agent; sulfonylurea.1 2 3 4

Uses for Glyburide

Diabetes Mellitus

Used alone or in fixed combination with metformin as an adjunct to diet and exercise for the management of type 2 (noninsulin-dependent) diabetes mellitus in patients whose hyperglycemia cannot be controlled by diet alone.1 2 3 4 49 50 51 52 53 54 55 56 57 58 59 60 158

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Used in combination with one or more other oral antidiabetic agents or insulin as an adjunct to diet and exercise in patients who do not achieve adequate glycemic control with diet, exercise, and oral antidiabetic agent monotherapy.1 124 126 158 162 165 166 168 169 170 195 196 197 198 199 200 201 202 203

Alternative therapy in some type 2 diabetic patients being treated with insulin.1 2 3 Useful in combination with insulin therapy to improve glycemic control and/or decrease insulin dosage in some type 2 diabetic patients.116 117 118 119 120 162 165 166 168 169 170

Not effective as sole therapy for patients with type 1 diabetes mellitus; 1 3 60 insulin is necessary.1 2 60

Not effective as sole therapy in patients with diabetes mellitus complicated by acidosis, ketosis, or coma; insulin is necessary.1 2 3

Glyburide Dosage and Administration

General

  • Adjust dosage according to patient’s tolerance and urine and/or fasting blood glucose determinations.1 2 Monitor glycosylated hemoglobin (hemoglobin A1c, HbA1c) to determine minimum effective dosage and to detect primary or secondary failure.1 2

  • During transfer from insulin therapy, patients should test their blood for glucose 2 60 106 and their urine for glucose and/or ketones at least 3 times daily.1 2 124 126 Persistent ketonuria with glycosuria, 1 2 ketosis, 86 and/or inadequate lowering or persistent elevation of blood glucose concentration 86 during transfer from insulin indicate the need for insulin therapy.1 2 86

  • Micronized formulations are not bioequivalent with conventional formulations; retitrate dosage when transferring patients from micronized to conventional formulations, or vice versa.124

Administration

Oral Administration

Administer conventional or micronized formulations once daily with breakfast or first main meal.1 2 3 124 May administer in 2 divided doses in some patients (i.e., those receiving >10 mg daily [as conventional formulations]1 2 or >6 mg [as micronized glyburide]).b

Administer fixed combination with metformin hydrochloride once or twice daily with a meal.158

Dosage

Adults

Diabetes Mellitus
Initial Dosage in Previously Untreated Patients
Oral

Conventional formulations: Initially, 2.5–5 mg daily.1 2

Micronized formulations: Initially, 1.5 –3 mg daily.124

Fixed combination with metformin hydrochloride: Initially, 1.25 mg of glyburide and 250 mg of metformin hydrochloride once daily.158 For severe hyperglycemia (baseline HbA1c >9% or fasting blood glucose >200 mg/dL), 1.25 mg of glyburide and 250 mg of metformin hydrochloride twice daily, given with the morning and evening meals.158

Initial Dosage in Patients Transferred from Other Oral Antidiabetic Agents
Oral

Conventional formulations: Initially, 2.5–5 mg daily.1 2

Micronized formulations: Initially, 1.5–3 mg daily.124

May discontinue most other oral hypoglycemic agents (except chlorpropamide) immediately.1 2 3 96 b During transfer from chlorpropamide (a drug with a long elimination half-life), monitor closely for hypoglycemia during initial 2 weeks of transition period.1 2 b

Fixed combination with metformin hydrochloride: Initially, 2.5 or 5 mg of glyburide and 500 mg of metformin hydrochloride twice daily with morning and evening meals in patients not adequately controlled by monotherapy with glyburide (or another sulfonylurea) or metformin.158 For patients previously receiving combination therapy with glyburide (or another sulfonylurea) and metformin, initial dosage should not exceed previous individual dosages of glyburide (or equivalent dosage of another sulfonylurea) and metformin.158 Titrate in increments ≤5 mg of glyburide and 500 mg of metformin hydrochloride to achieve adequate blood glucose control.158

Initial Dosage in Patients Transferred from Insulin
Oral

Conventional formulations: Initially, 2.5–5 mg once daily (if insulin dosage is <20 units daily) or 5 mg once daily (if insulin dosage is 20–40 units daily); may discontinue insulin immediately.1 2 96 If insulin dosage is >40 units daily, reduce insulin dosage by 50% and initiate glyburide at 5 mg daily; withdraw insulin gradually and increase glyburide dosage in increments of 1.25–2.5 mg daily every 2–10 days.1 2

Micronized formulations: Initially, 1.5–3 mg once daily (if insulin dosage is <20 units daily) or 3 mg once daily (if insulin dosage is 20–40 units daily); may discontinue insulin immediately.124 b If insulin dosage is >40 units daily, reduce insulin dosage by 50% and initiate glyburide at 3 mg daily; withdraw insulin gradually and increase glyburide dosage in increments of 0.75–1.5 mg daily every 2–10 days.b

Titration and Maintenance Dosage
Oral

Conventional formulations: Increase dosage in increments of ≤2.5 mg daily at weekly intervals.1 2 Usual maintenance dosage is 1.25–20 mg daily.1 2 96

Micronized formulations: Increase dosage in increments of ≤1.5 mg daily at weekly intervals.b Usual maintenance dosage is 0.75–12 mg daily.124

Fixed combination with metformin hydrochloride: Titrate in increments of 1.25 mg of glyburide and 250 mg of metformin hydrochloride daily at 2-week intervals to achieve adequate blood glucose control.158

Prescribing Limits

Adults

Conventional formulations: Maximum 20 mg daily.1 2 96

Micronized formulations: Maximum 12 mg daily.b

Fixed combination with metformin hydrochloride: Maximum 20 mg of glyburide and 2 g of metformin hydrochloride daily.158

Special Populations

Hepatic Impairment

Conventional formulations: Initially, 1.25 mg daily.1 2

Micronized formulations: Initially, 0.75 mg daily.124

Renal Impairment

Conventional formulations: Initially, 1.25 mg daily.1 2

Micronized formulations: Initially, 0.75 mg daily.124

Geriatric Patients

Conventional formulations: Initially, 1.25 mg daily1 2

Micronized formulations: Initially, 0.75 mg daily.124

Fixed combination with metformin hydrochloride: Do not titrate to maximum recommended dosage.158

Other Populations

Cautious dosing recommended in debilitated or malnourished patients or in patients with adrenal or pituitary insufficiency.1 2 124 158

Conventional formulations: Initially, 1.25 mg daily1 2

Micronized formulations: Initially, 0.75 mg daily.124

Fixed combination with metformin hydrochloride: Do not titrate to maximum recommended dosage.158

Cautions for Glyburide

Contraindications

  • Known hypersensitivity to glyburide or any ingredient in the formulation.1 2 158

  • Diabetic ketoacidosis, with or without coma.1 2 3

  • Monotherapy for type 1 diabetes mellitus.1 a

Warnings/Precautions

Warnings

Cardiovascular Effects

Increased cardiovascular mortality reported with other sulfonylurea antidiabetic agents (i.e., tolbutamide, phenformin).1 2 63 However, the American Diabetes Association considers the benefits of intensive glycemic control with insulin or sulfonylureas to outweigh the risks overall.128 130 131 138 144

Sensitivity Reactions

Dermatologic and Sensitivity Reactions

Possible allergic skin reaction (e.g., pruritus, erythema, urticaria, morbilliform or maculopapular eruptions).1 2 Discontinue the drug if allergic reaction persists.1 2

Angioedema, arthralgia, myalgia, and vasculitis reported.123

General Precautions

Hypoglycemia

Severe,1 2 67 68 69 74 105 occasionally fatal,67 68 74 105 hypoglycemia reported. Debilitated, malnourished, or geriatric patients and patients with renal or hepatic impairment or adrenal or pituitary insufficiency may be particularly susceptible.1 105 158 Strenuous exercise, alcohol ingestion, insufficient caloric intake, or use in combination with other antidiabetic agents may increase risk.1 2 96 105 Hypoglycemia may be difficult to recognize in geriatric patients or in those receiving β-adrenergic blocking agents.1 105 158 (See Interactions.)

Concurrent Illness

Possible loss of glycemic control during periods of stress (e.g., fever, trauma, infection, surgery).1 2

Temporary discontinuance of glyburide and administration of insulin may be required.1 2

Use of Fixed Combinations

When used in fixed combination with metformin hydrochloride, consider the cautions, precautions, and contraindications associated with metformin.

Specific Populations

Pregnancy

Category B.1

Many experts recommend that insulin be used during pregnancy.1 2 106

Lactation

Not known whether glyburide is distributed into milk; discontinue nursing or the drug.1 2

Pediatric Use

Safety and efficacy not established.1 2

Geriatric Use

Increased risk of hypoglycemia; hypoglycemia may be difficult to recognize.1 105 158 Cautious dosing recommended.1 2 124 158 See Geriatric Patients under Dosage and Administration.

Hepatic Impairment

Increased risk of hypoglycemia.1 2 96 105 106 Cautious dosing recommended.1 2 124 158 (See Hepatic Impairment under Dosage and Administration.)

Renal Impairment

Increased risk of hypoglycemia.1 2 96 105 106 Cautious dosing recommended.1 2 124 158 (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

With conventional and micronized formulations, nausea, epigastric fullness, heartburn.1 2 3 62

With fixed-combination glyburide/metformin hydrochloride preparation, upper respiratory tract infection, diarrhea, headache, nausea/vomiting, abdominal pain, dizziness.158

Interactions for Glyburide

When using fixed-combination preparation containing metformin hydrochloride, consider the drug interactions associated with metformin.158

Protein-bound Drugs

Potential pharmacokinetic interaction and possible potentiation of hypoglycemic effects when used concomitantly with other highly protein-bound drugs.1 2 37 38 39 40 62 85

Observe for adverse effects when glyburide therapy is initiated or discontinued and vice versa.1 2

Specific Drugs

Drug

Interaction

Comments

Alcohol

Possible disulfiram-like reactions1 2 87

Anticoagulants, oral

Possible displacement from plasma proteins and potentiation of hypoglycemic effects1 2 37 38 39 40 62 85

Observe for adverse effects when glyburide or oral anticoagulants are initiated or discontinued1 2

Antifungals, oral (i.e., fluconazole, miconazole)

Increased glyburide concentrations; possible hypoglycemia1 124 158 210 211

β-Adrenergic blocking agents

Impaired glucose tolerance60 62 85 or potentiation of hypoglycemic effects60 62 85

If concomitantly therapy is necessary, a β1-selective adrenergic blocking agent may be preferred62

Bosentan

Increased risk of elevated serum aminotransferase concentrations233

Concomitant use contraindicated233

Calcium-channel blocking agents

May exacerbate diabetes mellitus1 2 90

Observe carefully for loss of glycemic control or for hypoglycemia when calcium-channel blocking agents are discontinued1 124 158

Chloramphenicol

Potentiation of hypoglycemic effects1 2 60 62 85

Observe carefully for hypoglycemic effects or loss of glycemic control when chloramphenicol is discontinued1 124 158

Contraceptives, oral

May exacerbate diabetes mellitus1 2 62 85

Observe carefully for loss of glycemic or for hypoglycemia when oral contraceptives are discontinued1 124 158

Corticosteroids

May exacerbate diabetes mellitus1 2 62 85

Observe carefully for loss of glycemic control or for hypoglycemia when corticosteroids are discontinued1 124 158

Diuretics

May exacerbate diabetes mellitus1 2 62 85

Observe carefully for loss of glycemic control or for hypoglycemia when diuretics are discontinued1 124 158

Estrogens

May exacerbate diabetes mellitus1 2 62

Observe carefully for loss of glycemic control or for hypoglycemia when estrogens are discontinued1 124 158

Fluoroquinolone anti-infectives

Potentiation of hypoglycemic effects1 2 126

Observe carefully for hypoglycemic effects or loss of glycemic control when fluoroquinolone anti-infectives are discontinued1 124 158

Hydantoins

Possible displacement from plasma protein and potentiation of hypoglycemic effects1 2 37 38 39 40 62 85

Observe for adverse effects when glyburide or hydantoins are initiated or discontinued1 2

Isoniazid

May exacerbate diabetes mellitus1 2

Observe carefully for loss of glycemic control or for hypoglycemia when isoniazid is discontinued1 124 158

MAO inhibitors

Potentiation of hypoglycemic effects1 2 62 85

Observe closely for hypoglycemic effects of loss of glycemic control when MAO inhibitors are discontinued1 124 158

Niacin

May exacerbate diabetes mellitus1 2 62

Observe carefully for loss of glycemic control or for hypoglycemia when nicotinic acid is discontinued1 124 158

NSAIAs

Possible displacement from plasma proteins and potentiation of hypoglycemic effects1 2 37 38 39 40 62 85

Observe for adverse effects when glyburide or NSAIAs are initiated or discontinued1 2

Phenothiazines

May exacerbate diabetes mellitus1 2 62 85

Observe carefully for loss of glycemic control or for hypoglycemia when phenothiazines are discontinued1 124 158

Phenylbutazone

Potentiation of hypoglycemic effects84

Monitor blood glucose control; adjust glyburide dosage when phenylbutazone is initiated or discontinued85

Phenytoin

May exacerbate diabetes mellitus1 2 62

Observe carefully for loss of glycemic control or for hypoglycemia when phenytoin is discontinued1 124 158

Probenecid

Potentiation of hypoglycemic effects1 2 62

Observe closely for hypoglycemic effects or loss of glycemic control when probenecid is discontinued1 124 158

Rifampin

May exacerbate diabetes mellitus62 85

Observe carefully for loss of glycemic control or for hypoglycemia when rifampin is discontinued1 124 158

Sulfonamides

Possible displacement from plasma proteins and potentiation of hypoglycemic effects1 2 37 38 39 40 62 85

Observe for adverse effects when glyburide or sulfonamides are initiated or discontinued1 2

Sympathomimetic agents

May exacerbate diabetes mellitus1 2 62

Observe carefully for loss of glycemic control or for hypoglycemia when sympathomimetic agents are discontinued1 124 158

Thyroid agents

May exacerbate diabetes mellitus1 2 62 85

Observe carefully for loss of glycemic control or for hypoglycemia when thyroid agents are discontinued1 124 158

Glyburide Pharmacokinetics

Absorption

Bioavailability

Almost completely absorbed following oral administration.4 23 24 94

Onset

Hypoglycemic action generally begins within 45–60 minutes and is maximal within 1.5–3 hours.4 27 32 49

Duration

In nonfasting diabetic patients, the hypoglycemic action may persist for up to 24 hours.1 2 33

Food

Food does not affect rate or extent of absorption.27 28 94

Special Populations

In patients with renal1 2 27 or hepatic1 2 impairment, serum concentrations may be increased.

Distribution

Extent

Distributed in substantial amounts into bile.1 2 3 25 26 36

Appears to cross the placenta.81 101 Not known if distributed into breast milk.1 2

Plasma Protein Binding

>99% (for glyburide).7 25 37

>97% (for major metabolite 4-trans-hydroxyglyburide).25

Elimination

Metabolism

Appears to be completely metabolized, 25 26 31 36 probably in the liver.31

Elimination Route

Excreted as metabolites in urine and feces in approximately equal proportions.1 2 23 25 26 30 31 47

Minimally removed by hemodialysis.42

Half-life

1.4–1.8 hours (for glyburide)24 27 29 41 97 or approximately 10 hours (for glyburide and metabolites).25 30 31 32

Special Populations

In patients with severe renal impairment, clearance may be decreased and half-life prolonged.42 43

Stability

Storage

Oral

Conventional or Micronized Tablets

Well-closed containers at 15–30°C.1 2 124 126

Fixed-combination Tablets

Light-resistant containers up to 25°C.158

Actions

  • Stimulates secretion of endogenous insulin from beta cells of the pancreas.1 2 3 4 8 9 10 11 12 Lowers blood glucose concentration in diabetic and nondiabetic individuals.3 4 8 9 10 11

  • During prolonged administration, extrapancreatic effects (e.g., enhanced peripheral sensitivity to insulin, reduction of basal hepatic glucose production) contribute to the hypoglycemic action.4 8 9 10 11 12 15 16 17 110 111 112 121

Advice to Patients

  • Importance of regular clinical and laboratory evaluations, including urine and/or fasting blood glucose determinations.1 2

  • Importance of adhering to diet and exercise regimen.1 2

  • Risks of hypoglycemia, the symptoms and treatment of hypoglycemic reactions, and conditions that predispose to the development of hypoglycemic reactions.1

  • Understanding of primary and secondary failure to oral sulfonylurea antidiabetic agents.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Glyburide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

1.25 mg*

DiaBeta (scored)

Sanofi-Aventis

Glyburide Tablets

Greenstone, Sandoz, Teva

Micronase (scored)

Pfizer

2.5 mg*

DiaBeta (scored)

Sanofi-Aventis

Glyburide Tablets

Greenstone, Sandoz, Teva

Micronase (scored)

Pfizer

5 mg*

DiaBeta (scored)

Sanofi-Aventis

Glyburide Tablets

Greenstone, Sandoz, Teva

Micronase (scored)

Pfizer

Tablets (micronized)

1.5 mg*

Glyburide Micronized Tablets

Amide, Greenstone, Mylan, Stada, Teva, West-Ward

Glycron (scored)

Zoetica

Glynase PresTab (scored)

Pfizer

3 mg*

Glyburide Micronized Tablets

Amide, Greenstone, Mylan, Stada, Teva, West-Ward

Glycron (scored)

Zoetica

Glynase PresTab (scored)

Pfizer

4.5 mg*

Glycron (scored)

Zoetica

6 mg*

Glyburide Micronized Tablets

Amide, Greenstone, Mylan, Stada, Teva, West-Ward

Glycron (scored)

Zoetica

Glynase PresTab (scored)

Pfizer

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Glyburide Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

1.25 mg with Metformin Hydrochloride 250 mg*

Glucovance (with povidone)

Bristol-Myers Squibb

Glyburide with Metformin Hydrochloride Tablets

Actavis, Par, Sandoz, Teva

2.5 mg with Metformin Hydrochloride 500 mg*

Glucovance (with povidone)

Bristol-Myers Squibb

Glyburide with Metformin Hydrochloride Tablets

Actavis, Par, Sandoz, Teva

5 mg with Metformin Hydrochloride 500 mg*

Glucovance (with povidone)

Bristol-Myers Squibb

Glyburide with Metformin Hydrochloride Tablets

Actavis, Par, Sandoz, Teva

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Diabeta 1.25MG Tablets (SANOFI-AVENTIS U.S.): 50/$29.99 or 100/$49.97

Diabeta 2.5MG Tablets (SANOFI-AVENTIS U.S.): 30/$29.99 or 60/$57.97

Diabeta 5MG Tablets (SANOFI-AVENTIS U.S.): 30/$45.75 or 90/$127.09

Glucovance 2.5-500MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 60/$85.99 or 180/$249.98

Glucovance 5-500MG Tablets (B-M SQUIBB U.S. (PRIMARY CARE)): 60/$92.00 or 180/$246.06

GlyBURIDE 1.25MG Tablets (TEVA PHARMACEUTICALS USA): 30/$16.99 or 60/$23.98

GlyBURIDE 2.5MG Tablets (COREPHARMA LLC): 30/$16.99 or 90/$42.97

GlyBURIDE 5MG Tablets (TEVA PHARMACEUTICALS USA): 30/$18.99 or 60/$29.98

GlyBURIDE Micronized 1.5MG Tablets (DAVA PHARMACEUTICALS): 90/$26.99 or 180/$52.97

GlyBURIDE Micronized 3MG Tablets (DAVA PHARMACEUTICALS): 90/$15.01 or 180/$17.99

GlyBURIDE-MetFORMIN 2.5-500MG Tablets (ACTAVIS MID ATLANTIC): 60/$45.99 or 180/$125.96

GlyBURIDE-MetFORMIN 5-500MG Tablets (TEVA PHARMACEUTICALS USA): 100/$83.99 or 300/$246.97

Glynase 1.5MG Tablets (PFIZER U.S.): 60/$56.68 or 180/$155.35

Glynase 3MG Tablets (PFIZER U.S.): 60/$79.79 or 180/$239.37

Glynase 6MG Tablets (PFIZER U.S.): 60/$136.48 or 180/$388.46

Micronase 1.25MG Tablets (PFIZER U.S.): 30/$22.99 or 90/$68.97

Micronase 5MG Tablets (PFIZER U.S.): 30/$41.99 or 90/$114.96

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions January 30, 2012. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

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